In 2016, among U.S. mental health services treatment 

facilities:

 48.6% had a smoke-free campus,

 48.9% screened clients for tobacco use,

 37.6% offered tobacco cessation counseling,

 25.2% offered nicotine replacement therapy (NRT), and

 21.5% offered non-nicotine tobacco cessation 

medications.7

In 2016, among U.S. substance use disorder treatment facilities:

 34.5% had smoke-free campuses,

 64.0% screened clients for tobacco use, 

 47.4% offered tobacco cessation counseling, 

 26.2% offered NRT, and

 20.3% offered non-nicotine tobacco cessation medications.7

Promising Policies And Practices To Address Tobacco Use By 

Persons With Mental And Substance Use Disorders

People with mental and substance use disorders:

 Are approximately twice as likely as the general population to smoke cigarettes,

1

 Are more likely to die from smoking-related illness than from their mental and substance use disorders (i.e. behavioral 

health conditions),2,3 and

 Want to quit smoking and are able to do so successfully, which both reduces their risk of developing smoking-related 

diseases and may also improve their behavioral health outcomes.4,5,6

In recent years, states have made significant progress in addressing tobacco use and secondhand smoke exposure in 

behavioral health treatment settings. This document highlights efforts by some states in implementing one or more of these 

policies and practices. It could serve as a resource for tobacco control and behavioral health programs as they prioritize 

potential actions to address tobacco use among people with mental or substance use disorders.

Example: New York Implements Tobacco-Free Campus Policies

In 2008, New York became the first state to require that all state-funded or state-certified substance use disorder treatment 

programs (involving over 1,400 programs at the time) prohibit smoking on any property owned or operated by those programs, 

including outdoor areas.

8

The counselors and clinical supervisors reported that, at first, they had 

some problems with implementing and enforcing the policy. However, 

policy implementation improved over time.9,10

48.6

34.5

65.6

83

% OF MENTAL HEALTH 

TREATMENT FACILITIES 

WITH SMOKE-FREE 

POLICIES

% OF SUBSTANCE USE 

DISORDER TREATMENT 

FACILITIES WITH SMOKEFREE POLICIES

Percent

U.S. Overall New York

Strategy: Make Behavioral Health Treatment Settings Tobacco-Free

New York first addressed smoking at substance use disorder treatment facilities because of OASAS’s interest and readiness, 

given its knowledge of the linkages between treating nicotine addiction and treating other addictions. After OASAS 

implemented its policy, the Office of Mental Health decided to take a similar—but not identical—approach to address the 

burden of tobacco use on its clients. The Office of Mental Health partnered with the State Department of Health Bureau of 

Tobacco Control to train mental health providers and Department of Health grantees to help mental health facilities adopt and

implement tobacco-free campus policies. These policies prohibit the use of all types of tobacco products, including ecigarettes, on the entire campuses of mental health facilities, including outdoor areas. 

About one year after the New York Office of Alcoholism and 

Substance Abuse Services (OASAS) implemented this policy, 

counselors and clinical supervisors noted that: 

 Fewer clients were smoking,

 More clients were aware of the harms related to smoking, and 

 More clients wanted to quit and knew about resources to help 

them quit.9

JULY 2018
2

ODMHSAS staff say that these steps helped change the culture around tobacco use in behavioral health treatment settings in 

Oklahoma. After ODMHSAS took these steps, Oklahoma changed its behavioral health treatment regulations. Now Oklahoma

law requires that the above measures be taken by all substance use disorder treatment facilities and all state-funded or statecertified mental health facilities. ODMHSAS is now focusing on reducing tobacco use among clients at all mental health 

facilities in the state – even if these facilities are not state-certified or state-funded – to help improve health. 

This effort appears to be making an impact: Oklahoma has the highest proportion of mental health treatment facilities offering 

cessation counseling, offering non-nicotine cessation medications, and providing smoke-free campuses in the U.S. 

ODMHSAS staff report that only 45% of persons with a mental health condition who were served by ODMHSAS smoked in 

2017, down from 71% in 2011. During this same timeframe, the proportion of persons with a substance use disorder served 

by ODMHSAS that smoked fell from 77% to 51%.

The Oklahoma Tobacco Settlement Endowment Trust (TSET) works to reduce tobacco use in the state using funds from the 

Master Settlement Agreement.13 In 2011, TSET brought together Oklahoma’s Department of Mental Health and Substance 

Abuse Services (ODMHSAS) and State Department of Health to develop a plan to address tobacco use among behavioral 

health clients and providers. After this meeting, facilitated by the Smoking Cessation Leadership Center, TSET awarded 

grants to health system partners to help put the plan in place.14

Bureau staff report that the tobacco-free campus policies have resulted in social norm change with respect to tobacco use, 

making it easier for behavioral health providers to screen for tobacco use and help clients quit. Tobacco-free campus policies 

can reinforce tobacco-free norms and also eliminate exposure to secondhand smoke. To further support efforts by behavioral 

health providers to address tobacco use, partner agencies in New York created a cross-walk chart summarizing tobaccorelated requirements from several behavioral health regulatory agencies. The chart includes each agency’s regulations and 

recommendations on screening and treating clients (including at discharge), training staff, and adopting tobacco-free campus 

policies.11

These efforts have likely contributed to recent research findings showing that New York is the state with the highest proportion 

of substance use disorder treatment facilities that have smoke-free campuses, screen for tobacco use, offer cessation 

counseling, and offer nicotine replacement therapy.12

Over a five-year period, Oklahoma took the following steps:

 Trained behavioral health providers about tobacco and the state’s plan 

to reduce tobacco use,

 Required state-funded behavioral health facilities to have tobacco-free 

policies for staff and clients and show plans for enforcing the policies,

 Required state-funded behavioral health facilities to implement the “5 

A’s” (five steps for clinicians to help people quit tobacco: Ask, Advise, 

Assess, Assist, and Arrange15) or to refer clients who use tobacco to 

the state quitline, and

 Required state-funded behavioral health providers to track the number 

of clients they referred to the quitline and increase the proportion of 

clients referred each year. 

Example: Grant Funding in Oklahoma Changes Systems for Assessing and Addressing 

Tobacco Use

Strategy: Integrate Screening for Tobacco Use into Behavioral Health Treatment

48.9

64.0

75.0 81.9

% OF MENTAL HEALTH 

TREATMENT FACILITIES 

THAT ASK PATIENTS 

ABOUT TOBACCO USE

% OF SUBSTANCE USE 

DISORDER TREATMENT 

FACILITIES THAT ASK 

PATIENTS ABOUT 

TOBACCO USE

Percent

U.S. Overall Oklahoma
3

During 2013-2017, the Taking Texas Tobacco Free (TTTF) project, with funding from the Cancer Prevention and Research 

Institute of Texas, partnered with 22 community mental health treatment centers (representing over 250 individual clinics) to

put comprehensive and sustainable tobacco-free programs in place in Texas. The goal was to reduce tobacco use and 

secondhand smoke exposure among employees, clients, and visitors by adopting tobacco-free campus policies, screening 

employees and clients regularly for tobacco use, and providing counseling and NRT to tobacco users who want to quit.

25.2

43.8

% OF MENTAL HEALTH TREATMENT 

FACILITIES THAT OFFER NRT

Percent

U.S. Overall Texas

Over the four-year period:

 TTTF staff trained 5,172 mental health clinic employees (including 

those not providing direct clinical care) about tobacco use and its 

impact on persons with mental health conditions,

 TTTF staff trained employees providing direct clinical care about 

how NRT and non-nicotine cessation medication can help people 

quit tobacco, 

 TTTF staff provided tobacco dependence training to 150 of the 

employees providing direct clinical care,

 Clinicians at these facilities screened for tobacco use over 120,000 

times, and

 Over 15,000 individual boxes of nicotine patches, gum, or 

lozenges were provided to mental health treatment clinic clients 

and staff.16

Texas has the highest proportion of mental health treatment facilities that offer NRT.12 The Texas Department of State Health 

Services Tobacco Prevention and Control Program has said that providing “starter supplies” of NRT to behavioral health 

centers has made a difference; it has been easier for these facilities to implement tobacco-free campus policies and put in 

place processes to consistently screen clients for tobacco use because they have cessation tools on hand to support quit 

attempts. TTTF is now implementing a similar program with 18 substance use disorder treatment centers.

The Hawaii Department of Health Tobacco Prevention and Education Program (TPEP) surveyed behavioral health programs 

to learn more about their current cessation practices. Some steps that TPEP took to address tobacco use among persons with 

behavioral health conditions and increase counseling in Hawaii include:

 Partnered with the Hawaii Health Department’s Adult Mental 

Health Division to provide a series of trainings on tobacco 

interventions to behavioral health clinical staff, case managers, 

and social workers,

 Conducted a workshop for those same participants with a national 

expert on addressing tobacco use among persons with behavioral 

health conditions, and

 Worked with the state Attorney General’s Office to clarify that a 

state law allowing minors to consent to substance use disorder 

treatment without a parent’s permission also applies to tobacco 

cessation treatment, resulting in the state quitline and health 

providers being able to offer nicotine addiction counseling to more 

youth. 

Example: Provider Training Results in Hawaii Behavioral Health Facilities Providing 

Counseling to Help Clients Quit

Strategy: Counsel Behavioral Health Clients to Quit Using Tobacco

Example: Texas Provides NRT as Part of a Range of Tobacco Cessation Measures in Mental 

Health Treatment Settings

Strategy: Offer Behavioral Health Clients Nicotine Replacement Therapy (NRT)

37.6 47.4

62.2 66.7

% OF MENTAL HEALTH 

TREATMENT FACILITIES 

THAT OFFER 

COUNSELING TO HELP 

PEOPLE QUIT TOBACCO

% OF SUBSTANCE USE 

DISORDER TREATMENT 

FACILITIES THAT OFFER 

COUNSELING TO HELP 

PEOPLE QUIT TOBACCO

Percent

U.S. Overall Hawaii

The SAMHSA surveys show that Hawaii has a high proportion of both mental health treatment facilities and substance use 

disorder treatment facilities offering tobacco cessation counseling to clients.12
4

Example: New York and Oklahoma Make it Easier for Persons with Behavioral Health 

Conditions to Access Non-Nicotine Cessation Medications

Behavioral health facilities in New York and Oklahoma are national leaders in providing non-nicotine medications to help 

persons receiving treatment for mental or substance use disorders quit using tobacco. 

Medicaid pays for mental health treatment for more persons in the U.S. than any other insurer, and its role in paying for 

substance use disorder treatment is growing.17 State Medicaid programs are required to cover all seven medications, including 

two non-nicotine medications—varenicline and buproprion—approved by the Food and Drug Administration for smoking 

cessation.18,19 As of June 30, 2017, 32 states covered all seven of these medications for all traditional (non-expansion) 

Medicaid enrollees.20 However, barriers such as copayments, prior authorization, limits on the number of treatments allowed 

per year, or limits on how long treatment can be provided, may make it difficult for Medicaid enrollees to obtain these 

medications.20

New York’s Medicaid program pays for non-nicotine cessation 

medications.

21 Because most people who smoke make multiple quit 

attempts before succeeding, New York does not cap the number of 

times each year it will pay for the medication for a client insured 

through Medicaid.

21 This may be especially beneficial for behavioral 

health clients who smoke as they tend to be heavier smokers and may 

need extra help following medication regimens.

12With funding from 

New York’s Bureau of Tobacco Control to promote universal provision 

of tobacco dependence treatment services, the Center of Excellence 

for Health Systems Improvement:

 Gathered information from the state Bureau of Tobacco Control, the 

Office of Alcoholism and Substance Abuse Services, and the Office 

of Mental Health, 

 Outlined what each behavioral health regulatory body requires and 

recommends for providing tobacco cessation medication,11 and

 Drafted a Tobacco Dependence Treatment Financial Modeling Tool 

that, once finalized, will be piloted by Department of Health 

grantees assisting health care organizations. The Tool is intended 

to help the health care organizations better understand the costs 

and benefits of taking a range of steps to help people who smoke 

quit, including providing cessation medications on-site.

22

 Identified who was responsible for policy change,

 Gathered data about the costs of providing cessation medications, the number of people who would seek the medications, 

and the number of people who likely would quit using tobacco, and

 Showed what the return on investment would be if cessation medications were covered by Medicaid at no cost to the 

client.25

21.5 20.3

40.5

19.6

38.3 39.1

% OF MENTAL HEALTH 

TREATMENT FACILITIES 

OFFERING NON-NICOTINE 

CESSATION MEDICATIONS

% OF SUBSTANCE USE 

TREATMENT FACILITIES 

OFFERING NON-NICOTINE 

CESSATION MEDICATIONS

Percent

U.S. Overall Oklahoma New York

Similarly, Oklahoma’s Medicaid program pays for non-nicotine cessation medications.23 It does not limit the number of times 

each year a client insured through Medicaid can access bupropion, one of the two non-nicotine medications approved by the 

FDA for tobacco cessation.

24 The changes that were made to Oklahoma’s Medicaid program to provide this coverage stemmed 

from a partnership between the Oklahoma Health Care Authority, the Oklahoma Tobacco Settlement Endowment Trust, and 

the Oklahoma State Department of Health. The group:

Strategy: Offer Behavioral Health Clients Non-Nicotine Tobacco Cessation Medications

The proportion of Oklahoma mental health treatment facilities and the proportion of New York mental and substance use 

disorder treatment facilities providing non-nicotine medications to clients is nearly double the proportion of behavioral health 

treatment facilities doing so elsewhere in the U.S.12
5

_____________________________________________________________________________________________

1 Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health (NSDUH), 2008-2015. 2015. Available 

from: https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collections/reports-detailed-tables-2015-NSDUH. 

2 Schroeder SA, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse 

problems. Annual Review of Public Health, 31:297—314, 2010.

3 Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding Excess Mortality in Persons With Mental Illness: 17-Year Follow 

Up of a Nationally Representative US Survey. Medical Care; 49(6):599–604, 2011.

4 Centers for Disease Control and Prevention. Vital Signs Fact Sheet: Adult Smoking Focusing on People With Mental Illness. 2013. Available 

from: https://www.cdc.gov/vitalsigns/smokingandmentalillness/index.html. 

5 Prochaska JJ, Das S, Young-Wolff KC. Smoking, mental illness, and public health. Annual Review of Public Health, 38:165-185, 2017.

6 Weinberger AH, Platt J, Esan H, Galea S, Erlich D, Goodwin RD. Cigarette Smoking Is Associated With Increased Risk of Substance Use 

Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation. The Journal of Clinical Psychiatry, 2(78):e152—e160, 

2017.

7 Additional information on N-MHSS is available at: 

https://www.samhsa.gov/data/sites/default/files/2016_National_Mental_Health_Services_Survey.pdf. Additional information on N-SATSS is 

Additional State Activities

The activities listed above are just some of the steps that states are taking to help people with behavioral health conditions quit 

tobacco. States are also taking other innovative steps in this area. 

For example, in addition to providing cessation support to clients while they are receiving behavioral health treatment, stateFor example, in addition to providing cessation 

support to clients while they are receiving 

behavioral health treatment, state-funded and 

state-certified behavioral health treatment 

facilities in OKLAHOMA provide clients 

discharged from crisis, in-patient, and residential 

treatment facilities with a short-term supply of 

free NRT until they can obtain additional free 

NRT from the state quitline or another source. 

Behavioral health providers also check on 

clients’ progress in quitting tobacco during a 

follow-up call which takes place within 30 days 

of discharge.

To increase cessation support in the community, KENTUCKY

empowered pharmacists to provide tobacco cessation counseling and 

medications. Previously, pharmacists could not provide cessation 

medications on their own to help people quit using tobacco. In 2016, the 

Tobacco Prevention and Cessation Program within the Kentucky Cabinet 

for Health and Family Services worked with the state Pharmacy Board to 

help pharmacists and doctors enter into collaborative care agreements26

allowing pharmacists to recommend cessation medications and provide 

brief cessation counseling. In late 2017, the Kentucky Pharmacy Board 

changed its rules to further empower pharmacists, allowing pharmacists 

to provide cessation medications and more extensive cessation 

counseling on their own.27,28 This will allow persons with behavioral 

health conditions—and others—increased access to cessation services.

Other evidence-based strategies to address tobacco use among people with behavioral health conditions include: 

 Adopting or changing health systems’ screening processes and electronic health record systems to make sure that 

providers ask and counsel clients about tobacco use and, if appropriate, provide them with cessation medications.12

 Continuing to educate behavioral health providers about the evidence that people with behavioral health conditions who 

smoke want to quit and benefit from quitting, while acknowledging that they may require longer or more intensive 

cessation treatment than people without such conditions.12,29

 Working with state Medicaid programs to cover evidence-based cessation treatments (including individual, group, and 

telephone counseling and the seven FDA-approved cessation medications), to remove barriers to accessing these 

treatments, and to promote awareness of this coverage among Medicaid enrollees and their health care providers to 

increase use of these treatments. Removing barriers, such as copayments, prior authorization, limits on the number of 

treatments allowed per year, or limits on how long treatment can be provided, can make it easier for people to access 

cessation treatment and encourage smokers to follow through on a quit attempt.20

 Continuing to reduce the appeal, accessibility, and social acceptability of tobacco and tobacco use. Not only will this 

reduce tobacco use in the general population, it will also help support targeted efforts to reduce tobacco use among 

people with behavioral health conditions. Proven methods include implementing comprehensive smoke-free laws, 

increasing the price of tobacco products, and conducting high-impact media campaigns.30 Ideally these campaigns can 

feature messages and testimonials specifically geared to persons with behavioral health conditions, such as Rebecca’s 

story from the Tips from Former Smokers® Campaign.31

The activities described here are examples of some of the strategies that tobacco control and behavioral health programs have 

taken as they have worked together to reduce tobacco use among people with mental and substance use disorders. Quitting 

smoking not only improves physical health but may also improve behavioral health outcomes in this population. For this 

reason, behavioral health treatment facilities are important settings for delivering evidence-based tobacco cessation 

interventions.
6

available at: https://www.samhsa.gov/data/sites/default/files/2016_NSSATS.pdf. Additional information about the survey results can be found at: 

Marynak K, VanFrank B, Tetlow S, et al. Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse 

Treatment Facilities—United States, 2016. Morbidity and Mortality Weekly Report, 67(18):519—523, 2018. Available from: 

https://www.cdc.gov/mmwr/volumes/67/wr/mm6718a3.htm. 

8 de Tormes Eby LT, Laschober T. Clinicians’ Perceptions of Implementation Extensiveness of 100% Tobacco Free Practices: A Longitudinal 

Study of New York State. Journal of Behavioral Health Services & Research, 41(1):50—63, 2013.

9 de Tormes Eby LT, Sparks TE, Evans E, Selzer JA. A Qualitative Examination of the Positive and Negative Consequences Associated With 

Going Tobacco-Free in Substance Abuse Treatment: The NY State Experience. Nicotine & Tobacco Research, 14(12):1407—1417, 2012.

10 de Tormes Eby LT, Laschober TC. Perceived Implementation of the Office of Alcoholism and Substance Abuse Services (OASAS) TobaccoFree Regulation in NY State and Clinical Practice Behaviors to Support Tobacco Cessation: A Repeated Cross-Sectional Study. Journal of 

Substance Abuse Treatment, 45(1):83—90, 2013.

11 Center of Excellence for Health Systems Improvement. Behavioral Health Tobacco Dependence Regulation Crosswalk. 

http://www.tobaccofreeny.org/images/PDFs/Behavioral_Health_Tobacco_Dependence_Treatment_Regulation_Crosswalk.pdf. Accessed March 

29, 2018.

12 Marynak K, VanFrank B, Tetlow S, et al. Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse 

Treatment Facilities—United States, 2016. Morbidity and Mortality Weekly Report, 67(18):519—523, 2018.

13 The Oklahoma Tobacco Settlement Endowment Trust. http://tset.ok.gov/content/about-us. Accessed March 29, 2018. The Master Settlement 

Agreement, stemming from litigation between 46 states and the major tobacco companies, results in payments from the tobacco industry to the 

states each year.

14 Smoking Cessation Leadership Center. Leadership and Policy Academies. https://smokingcessationleadership.ucsf.edu/leadership-andpolicy-academies. Accessed March 29, 2018.

15 The five major steps to help people quit are commonly referred to as the “5 A’s,” because each step begins with the letter A: Ask patients 

about tobacco use; Advise patients to quit using tobacco; Assess whether patients are ready to try to quit; Assist patients who want to quit by 

offering them counseling, NRT, or non-nicotine medication; and Arrange for a follow-up discussion. Agency for Healthcare Research and 

Quality. Five Major Steps to Intervention (The “5 A’s”). Available from https://www.ahrq.gov/professionals/clinicians-providers/guidelinesrecommendations/tobacco/5steps.html. Accessed March 29, 2018.

16 More information about Taking Texas Tobacco Free and its implementation guide, including sample tobacco-free policies, tobacco use 

assessments, and NRT distribution policies, can be found at https://www.takingtexastobaccofree.com/toolkit.

17 Centers for Medicare and Medicaid Services. Medicaid Benefits: Behavioral Health Services. 

https://www.medicaid.gov/medicaid/benefits/bhs/index.html. Accessed April 11, 2018.

18 American Lung Association. Tobacco Cessation Treatment: What is Covered? http://www.lung.org/our-initiatives/tobacco/cessation-andprevention/tobacco-cessation-treatment-what-is-covered.html. Accessed April 24, 2018.

19 Centers for Medicare and Medicaid Services. State Medicaid Director Letter, SDL # 11-007. 2011. Available from 

https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD11-007.pdf.

20 DiGiulio A, Jump Z, Yu A, et al. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments – United 

States, 2015-2017. Morbidity and Mortality Weekly Report, 67(13):390—395, 2018.

21 New York Department of Health. Getting Help Quitting. 

https://www.health.ny.gov/prevention/tobacco_control/campaign/quit_smoking/quit.htm. Accessed May 21, 2018.

22 Center of Excellence for Health Systems Improvement. Tobacco Dependence Treatment Financial Modeling Tool. 

http://tobaccofreeny.org/images/hsi/Resources/Financial_Modeling_Tool/Guidance-Document-TDT-Financial-Modeling-Tool-FINAL.pdf. 

Accessed March 30, 2018.

23 Oklahoma Health Care Authority. Thinking About Quitting Smoking? https://www.okhca.org/individuals.aspx?id=2733. Accessed May 21, 

2018.

24 Oklahoma Health Care Authority. SoonerCare Tobacco Cessation Benefit. http://www.okhca.org/providers.aspx?id=2735. Accessed April 17, 

2018.

25 For more information about Oklahoma’s work to expand Medicaid coverage for tobacco cessation treatment, see American Lung Association. 

Medicaid Tobacco Cessation Coverage in Oklahoma: A Case Study in Leveraging Systems and Partnerships. Available from: 

https://www.cdc.gov/tobacco/quit_smoking/cessation/pdfs/oklahoma-medicaid-tobacco-cessation_TAG508.pdf. Note that this case study 

indicated that there were limits on the amount of medications Medicaid enrollees could access each year, and that the partnership was working 

on removing those caps on all FDA-approved cessation medications, except varenicline. Since the case study was written, the partnership 

achieved this goal. 

26 For more information about Pharmacist Collaborative Practice Laws, see Centers for Disease Control and Prevention. Select Features of 

State Pharmacist Collaborative Practice Laws. 2013. Available from: https://www.cdc.gov/dhdsp/pubs/docs/pharmacist_state_law.pdf. 

27 State of Kentucky Administrative Regulations, Chapter 201, Section 2:380. http://www.lrc.state.ky.us/kar/201/002/380reg.htm. Accessed 

March 30, 2018.

28 Kentucky Board of Pharmacy. Board Meeting Minutes, December 20, 2018. 

https://pharmacy.ky.gov/BoardInformation/2017%20Board%20Meetings/December%2020,%202017.pdf. Accessed March 30, 2018.

29 Smoking Cessation Leadership Center and Substance Abuse and Mental Health Services Administration. Enhance Your State’s Tobacco 

Cessation Efforts Among the Behavioral Health Population. 2016. Available from: 

https://smokingcessationleadership.ucsf.edu/sites/smokingcessationleadership.ucsf.edu/files/State%20TA%20Resource%20on%20Tobacco%2

0Cessation%20in%20BH_June%202016_final.pdf. 

30 U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon 

General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014.

31 Centers for Disease Control and Prevention. Tips from Former Smokers®: Rebecca’s Story. Available from 

https://www.cdc.gov/tobacco/campaign/tips/stories/rebecca.html. 

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